COLLABORATIVE GOVERNANCE AND THE IMPLEMENTATION OF THE RYAN WHITE CARE ACT: A CASE STUDY OF HIV HEALTH SERVICES PLANNING COUNCILS IN TWO SOUTH FLORIDA COUNTIES by James K. Agbodzakey A Dissertation Submitted to the Faculty of The College of Architecture, Urban and Public Affairs in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Florida Atlantic University Boca Raton, FL December 2009 Copyright by James K. Agbodzakey 2009 ii VITA James K. Agbodzakey earned a Bachelor of Arts degree in Political Science from the University of Ghana, Legon, in 1999. In 2001, he was awarded graduate fellowships from Ohio University in Athens where he received a Masters of Arts degree in International Affairs and Masters of Public Administration degree. In 2005, he was also awarded a graduate teaching assistantship from the Florida Atlantic University’s School of Public Administration to pursue a Ph.D. in Public Administration. He received 2008 First Place FAU National Association of Graduate-Professional Students (NAGPS) Nationwide President’s Award. He is a member of Pi Alpha Alpha, the NASPAA honor society. He interned with the United Nation’s Department of Social and Economic Affairs in 2005 and was a temporary project associate for the International Monetary Fund in 2005. He has also been a project associate for the FAU Public Procurement Research Center. He was a presenter at the Florida Political Science Association Conferences in Orlando and St. Petersburg in 2007 and 2008 respectively. iv ACKNOWLEDGMENTS I have been blessed in many ways and being given the opportunity to pursue graduate studies in the United States is one such blessing. I am grateful to the ONLY WISE GOD for his immeasurable faithfulness and for using His Precious “vessels” to be a blessing in every unique situation. There are many individuals, families and communities to whom I owe a deep sense of gratitude. Special thanks to my Grandma-Sofonke for her unending love and constant support, Grandpa Akoeda, Uncle John K, Mr. Datsomor and my parents Georgina and George, for their sacrifices, and to my brothers and sisters in Ghana and Nigeria. I would like to express my profound appreciation to Dr. Khi V. Thai for his understanding and encouragement throughout this project. Likewise, I would like to express a special thanks to my other committee members, Dr. Cory-Scruggs for her commitment to my success, Dr. McCue for the pursuance of excellence, and to Dr. Aubrey for her support over the years and for the genuine interest in ensuring my intellectual development. I would also like to thank the program director, Dr. Miller, the faculty of the School of Public Administration as well as Mrs. Champagnie for their contributions to my academic development; and to Dean Carter, Mr. Clinton, Mr. Hedrick, Mrs. Zinn, Dr. v Espirito Santos, and the staff of the College of Architecture, Urban and Public Administration for their invaluable contribution to the promotion of academic growth for local and international students. My colleagues in the program have also earned my deep gratitude especially Dr. Schrouder, Dr. Taylor and Mrs. Keeler. I am also grateful to the African/Ghanaian communities in Athens, Columbus, Ohio, and Morgantown, West Virginia, and to the faculty and staff of the Political Science Department of Ohio University and the University of Ghana, Legon. Special thanks to Deborah Cuisick, Lim Swee Hock, Dr. Heh, Dr. Adugu, Mike Keeler, Sandra Ekpenyong, Don and Cathy Karpinen, Bob Morgans, Ron and Lynn Chapman, the members of Victory Christian Center, United Pentecostal Church, members and staff of the Broward County’s and Palm Beach County’s HIV Health Services Planning Councils, and the Assistant County Attorney for Broward County’s HIVPC for their immeasurable assistance in providing the data for my dissertation. vi ABSTRACT Author: James K. Agbodzakey Title: Collaborative Governance and the Implementation of the Ryan White Care Act: A Case Study of HIV Health Services Planning Councils in Two South Florida Counties Institution: Florida Atlantic University Dissertation Advisor: Dr. Khi V. Thai Degree: Doctor of Philosophy Year: 2009 The complex problems of the twenty-first century cannot be effectively addressed with twentieth century top-down bureaucratic governance alone because of limited stakeholder participation in collective decision making and/or implementation. The somewhat limited stakeholder participation in the policy process, especially, that of target populations, can impact generating viable solutions to complex problems. Collaborative governance has emerged as a promising alternative to traditional management in addressing contemporary complex problems. Collaborative governance is thus a type of governance that promotes joint participation of state and non-state stakeholders in decision making and/or implementation by using agreed upon processes of engagement to collectively address problems. Such governance is especially beneficial for addressing vii the challenges posed by the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). This dissertation uses the collaborative governance concept to explicate the efforts of HIV Health Services Planning Councils in Broward County and Palm Beach County of South Florida with the purpose of accentuating how collaborative governance works in providing various categories of services to meet the needs of people with AIDS (PWAs), as part of the implementation of the Ryan White CARE Act. The study focuses on critical variables of collaborative governance such as facilitative leadership and institutional design, the collaborative process variables such as trust building, commitment to the process and shared understanding, and outputs such as allocation priorities of the Councils. This study employed mixed methods in collecting data from various relevant sources. The combined findings from surveys, interviews, observations and document reviews were essential to knowledge and understanding of collaborative governance of the respective Councils. The results revealed more similarities than differences between the Councils in their efforts towards addressing the HIV/AIDS problem. The Councils are similar in all variables of collaborative governance with few exceptions relative to facilitative leadership and institutional design. The differences were relative to membership, number of committees, amount allocated for various service categories and number of clients served. Furthermore, the Councils were slightly different in reaching consensus on subjects of deliberation. On the average, Palm Beach County’s Council make decisions by consensus relatively easily when compared with the Broward viii County’s Council. Nonetheless, both Councils are consensus-oriented and strive to make decision by consensus as evidenced by unanimous votes or simple majority votes on various subjects of deliberation. In addition, representation and participation of target populations in collaborative governance have contributed to the empowerment of those target populations. The study contributes to the literature by developing a conceptual model for HIV/AIDS collaborative governance for producing outputs to help meet needs of target populations. Also, the study contributes to collaborative governance theorizing by drawing a nexus between variables of collaborative governance and by complementing the existing non-linear perspective of collaborative process for collective problem solving. Collaborative governance involving state and non-state stakeholders thereby enhances efforts of public managers by harnessing resources to effectively manage and/or address complex problems for the benefit of society. ix NOTE The Broward County HIV Health Services Planning Council is referenced as Broward County’s Council. Also, the Palm Beach County HIV Comprehensive AIDS Resources Emergency (CARE) Council is referenced as Palm Beach County’s Council. For citation purposes, Broward County HIVPC is used to reference the documents of the Broward County HIV Health Services Planning Council, and CARE Council or Palm Beach County HIVCC is used to reference the Palm Beach County HIV Comprehensive AIDS Resources Emergency (CARE) Council. The word Councils is used to reference both Broward County HIV Health Services Planning Council and Palm Beach County HIV Comprehensive AIDS Resources Emergency (CARE) Council. Outputs of the Councils not outcomes are the focus of this study in view of the objective of the study. The literature suggests outputs and/or outcomes are the results of collaborative governance. x COLLABORATIVE GOVERNANCE AND THE IMPLEMENTATION OF THE RYAN WHITE CARE ACT: A CASE STUDY OF HIV HEALTH SERVICES PLANNING COUNCILS IN TWO SOUTH FLORIDA COUNTIES List of Tables ................................................................................................................... xiv List of Figures ....................................................................................................................xv CHAPTER ONE: INTRODUCTION ..................................................................................1 1.1 Purpose of the Study ..............................................................................................10 1.2 Research Questions ................................................................................................13 1.3 Organization of the Study ......................................................................................15 CHAPTER TWO: CONCEPTUAL